title: Surgical-office-based versus radiology-referral-based breast ultrasonography: a comparison of efficiency, cost, and patient satisfaction.
abstract: BACKGROUND
  The differences in efficiency, cost of care, and patient satisfaction between surgical-office-based (SB) breast ultrasonography by the surgeon and radiology-referral-based (RB) ultrasonography by the radiologist in the workup of lumps and imaging abnormalities have not been computed.
  
  
  METHODS
  Charts of 61 consecutive patients requiring breast ultrasonography at the Comprehensive Breast Center from October through December 2005 were evaluated. The SB ultrasonography approach was compared with the RB approach. Matching variables were patient age, presenting complaint, Gail risk score, ultrasonography findings, interventional procedure, and histopathology reports. Outcomes variables were efficiency (time from presentation and establishment of diagnosis), cost of care, and patient satisfaction.
  
  
  RESULTS
  Twenty-nine patients had RB and 32 had SB breast ultrasonography. The RB and SB groups were similar in age, Gail risk, and ultrasonography findings. Median time to establish diagnosis in the RB group was 23 days, versus 1 day in the SB group (p < 0.0001). Median cost of care in the RB versus SB group was $659.00 versus $369.50 (p = 0.253), and net revenue generated was $85.00 versus $195.00 (p = 0.005), respectively. Forty-nine of 61 (80.3%) patients responded to the satisfaction survey. Forty-seven of 49 (96%) patients expect the diagnosis to be established within 48 hours. Twenty-eight of 28 (100%) patients in the SB group regarded their imaging study to be efficient, versus 5 of 21 patients in the RB group (p = 0.005); 16 of 21 in the RB group versus 26 of 28 in the SB group thought they adequately understood the ultrasonography findings at the time of study (p = 0.051). Twenty-four (86%) SB patients versus 14 (67%) RB patients rated overall experience as excellent (p = 0.055).
  
  
  CONCLUSIONS
  SB breast ultrasonography is an efficient, cost-effective, and patient-friendly approach to breast problems.
authors.affiliation: Department of Surgery, UMass Memorial Health Care, Worcester, MA 01605, USA. layeequr@ummhc.org
authors.forename: Rakhshanda
authors.initials: R
authors.lastname: Layeequr Rahman
authors.forename: S
authors.initials: S
authors.lastname: Crawford
authors.forename: Tracey
authors.initials: T
authors.lastname: Hall
authors.forename: Diane
authors.initials: D
authors.lastname: Bavosi
authors.forename: Robert
authors.initials: R
authors.lastname: Quinlan
mesh_terms: D000328:Adult; D001941:Breast Diseases / Q000000981:diagnostic imaging* / Q000628:therapy; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D013502:General Surgery; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D011871:Radiology; D012017:Referral and Consultation / Q000191:economics; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016217:Ultrasonography, Mammary / Q000191:economics